Provider Enrollment Specialist II
Description
At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Flexible schedules and work-from-home opportunities
- Strong track record of providing excellent work/life balance
- Comprehensive benefits package and competitive compensation
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
What you’ll be doing:
The Provider Enrollment Specialist II directly impacts the financial stability of the Company because he/she is the SCP Health representative who coordinates the provider number approval process. The Provider Enrollment Specialist, using his/her knowledge of SCP Health policies in conjunction with insurance carrier credentialing and enrollment requirements, facilitates provider enrollment and billing privileges on behalf of all SCP Health applicants through coordination of insurance plan enrollment and credentialing activities among various parties, including the Provider, Operations staff, Insurance Carrier and Billing Company Representatives.
The Provider Enrollment Specialist II directly impacts the financial stability of the Company because he/she is the SCP Health representative who coordinates the provider number approval process. The Provider Enrollment Specialist, using his/her knowledge of SCP Health policies in conjunction with insurance carrier credentialing and enrollment requirements, facilitates provider enrollment and billing privileges on behalf of all SCP Health applicants through coordination of insurance plan enrollment and credentialing activities among various parties, including the Provider, Operations staff, Insurance Carrier and Billing Company Representatives.
- Process and maintain provider applications for enrollment and re-enrollment for Medicare, Medicaid, BCBS and/or Commercial payors in accordance with Federal and State guidelines.
- Prioritize and manage multiple enrollments in a deadline-driven environment.
- Distribute, log, receive and scan Provider Enrollment Packets as assigned.
- Update National Provider Database information as needed.
- Monitor credentials, i.e. Medical License, DEA to ensure they are active and in good standing.
- Submit updated credentials to payors when credentials have expired to ensure no lapse in enrollment.
- Serve as the primary contact for providers and payors when questions regarding enrollment/re-enrollment arise.
- Identify any issues with providers eligibility to participate in Government plans.
- Advise Supervisor/Manager immediately of any eligibility issues for providers.
- Procure all documents needed from Provider to enroll timely.
- Perform data entry of submitted applications in Provider database record along with any documentation related to the enrollment process.
- Perform follow up on submissions via online, email or phone according to policies and procedures to ensure timely approval is received.
- Monitor Provider Enrollment AR on Hold reports for any held enrollment that should not be holding and identify and research any providers withheld AR of 120 days to ensure no issues exist.
Who/What we are looking for:
- HS Diploma required.
- B.A. in Healthcare or Business Administration or equivalent experience preferred.
- Work independently utilizing documented processes and automated daily reports generated from database.
- Must work independently with little or no oversight.
- When payor requirements change, must be able to analyze and compare processes in order to recommend process solutions to Management.
- Agility in managing multiple priorities with strong organizational and time management skills.
- Knowledge of Payor Credentialing processes, both Par and Non-Par.
- Knowledge of Provider Credentials.
- Experience working in CAQH database and National Provider Identifier database
- Knowledge of CMS Regulations and guidelines.
To learn more about SCP Health, please visit:
www.scp-health.com
www.scp-health.com
Join our social circle:
SCP Health is an Equal Opportunity Employer.
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